'NORMAL' EATING

'Normal' eating can be classified as many things in a person without diabetes but for a person with diabetes it is a very complex issue. Diabetes combined with an eating disorder makes this situation even more complex, but it can be done, it just needs to be done very carefully.

At first, approach the two things separately - the eating disorder first, and the diabetes second. I say this because if the eating is not stabilised, your diabetes management will be all over the place. Here are a few tips to 'normalise' your eating --

1) Begin by eating 3 solid meals a day. You may want to incorporate 2 snacks in as well but beware you will need to bolus for these and this may be triggering i.e. taking extra insulin. Try to eat at the same time each day i.e. breakfast at 8am, lunch at 12.30 and dinner at 6pm. This will help regulate not only your insulin regime and blood sugars but your metabolism. You may find it useful to write yourself out a 'meal plan' to follow like you would if you were in an inpatient programme. This will help you to have something to refer to when eating is difficult and will help keep you on the straight and narrow i.e. not eating too much and not eating too little. Do not eat less than planned or more than planned - if you overeat you may feel you have 'blown it' and get into a binge/insulin restriction cycle. If you eat less than planned you will naturally feel deprived and will be predisposed to a binge.

2) At first, try to avoid foods that are likely to trigger a binge or create too many feelings of guilt. This may be food high in carbohydrates or calories. You will have time to reintroduce these foods in to your life and insulin regime again but for the early stages of getting back to normal eating avoidance is best. However if you are in the safety of inpatient I recommend you approach challenging foods as soon as possible to get used to them so that you can feel comfortable.

3) If you have also been restricting food you will need to very gradually reefed yourself with foods that are easier on the digestive system. You may want to start off with foods that not only will be easy on your stomach but also your sugar levels i.e. porridge, soup etc. Once your stomach begins to get used to this food (i.e. after a few days) begin to slowly reintroduce solid foods.

4) Stop weighing yourself. It will be downright impossible to carry on eating without overwhelming feels of guilt if you are continuously weighing yourself. It will be inevitable that if you have been restricting insulin and you go back to insulin and food you will gain water weight; this is the bodies way of healing itself. Weighing yourself will give you an incorrect reading of your weight at this point. You are more than a number on the scale!

5) Live one day at a time. If this is too overwhelming, live an hour at a time. Every hour that passes you have a new opportunity to start again. If you cut out insulin one hour, make a promise to yourself to inject the next hour. It is never too late in the day to start again - if you wait until tomorrow the feeling of motivation may have passed. Live one meal at a time, one injection at a time etc. Living week by week or month by month can feel too overwhelming.

6) To begin with, eat mechanically i.e. eating your meals at a pre-planned time whether you are hungry or not. You may have lost your hunger warning signs but these will return and eventually you will begin to know your own body again i.e. when you are hungry and when you are full.

7) Eat foods that not only will benefit your health and diabetes management but foods you ENJOY. I.e. if you eat salad because it is low in calories but it makes you gag then STOP. Food is on the earth to enjoy, not to have to force down!

HOW TO GET YOUR DIABETES MANAGEMENT BACK ON TRACK -

When we manipulate insulin it does all sorts of crazy things to the body and re-stabilisation can be a long and ongoing process. Here are a few tips to get your diabetes management back on track after a bout of poor control/relapse.

1) Bear in mind that ketosis does weird and wacky things to our body's chemistry i.e. if you are running high constantly for weeks or months when you start regularly taking insulin again your sugar levels will not just return to a good and healthy level, they will take time. Do not feel disappointed in yourself or give up when you begin taking insulin but still get high readings. Your body is learning to trust you again.2) Beware that, for a while, 'normal' readings may feel like a hypo. This is because your body has been so used to running high and has adapted to this feeling. As time goes by your body will readjust and your hypo warning signs will come back when you are really having a hypo.3) When going back to insulin you may want to test more frequently than usual to check you are not over/under injecting. As mentioned before, blood sugars will be all over the place at first and may spike quite quickly and rapidly. I would advice testing your blood sugar at every meal and a few hours after every meal to ensure everything is running smoothly as best possible.4) If you suffer with diabetic retinopathy (eye damage) then you need to be extremely careful when getting your diabetes re-stabilised. Blood sugars and HBA1C levels must come down GRADUALLY and not rapidly as the more rapidly they come down, the faster damage can be accelerated to the eye. However if you get blood sugars down gradually over a 2-3 week period, no extra damage should occur.5) Go low-GI. Not low carbohydrate; low-GI. This is the recommended diet for anybody with diabetes as 'GI' is a measurement that affects how quickly our blood sugar goes up when eating certain foods. For more information go here. Eating low to medium GI foods will not only keep you fuller for longer and help keep your weight stable but also will keep blood sugars extremely stable. This is not a diet, it is a way of living and is simply healthy eating. It would greatly benefit anyone to follow a low-gi way of eating. 6) Exercise, exercise, exercise! No, I am not asking you to become a gym bunny here; I swear by a 30-minute walk everyday and doing extra little things to keep my steps up i.e. taking the stairs instead of an escalator. The tiniest things can have a huge impact on blood sugars when it comes to exercise. Moderate exercise will also keep your weight stable and enable you to maintain a healthy weight. On top of all these lovely factors, exercise increases insulin resistance, which means you need to inject less which is obviously - psychologically - extremely beneficial for somebody suffering with diabulimia.7) Last but not least - whilst on the subject of insulin sensitivity - if you are particularly put off insulin because you are quite insulin resistance and require quite a lot of insulin, ask your doctor if you can try metformin. Metformin is a drug in tablet form that increases insulin sensitivity therefore you need to inject less of it. I nearly had to halve my doses when I began to take it - this was extremely good for improving my attitude and relationship with insulin as I began to no longer see it as the enemy as much. Metformin also helps with appetite and weight control. For a study on metformin and type 1 diabetes please click here.